Chronic Back and Neck Pains: Those That Heal; Those That Don t
|
|
- Karin Garrison
- 6 years ago
- Views:
Transcription
1 Paul Gordon, M.A. Advanced Rolfer 875 Massachusetts Avenue, Cambridge, Massachusetts Mast Cove Road, Eliot, Maine From: The Physical Therapy Forum, Feb. 22, 1988 Chronic and Neck Pains: Those That Heal; Those That Don t Paul Gordon, MA, Certified Rolfer Recently a client of mine, whom I shall call Rosalie, turned and asked, Will I ever get better? It was a sad moment in what had been a difficult week for her. Rosalie is working her way along the long, slow path of healing a chronic back pain. She had badly injured the left side of her neck and upper back in a car accident two years ago and has progressed, step by step, from those first hours after the crash when she was wounded and completely dysfunctional. (See charts 1 and 2.) She went through the black days when she hurt all the time. She s seen the pain decrease: it was only a few months that she hurt irregularly. These days she feels ok but she is still vulnerable (although she certainly didn t this week). Rosalie is better; she just isn t healed. Chart 1 (Healthy Versus Damaged) Tissue State Examples Demand Response Description Healthy Healthy Damaged Damaged Rosalie s R Rosalie s R Rosalie s L Rosalie s L Normal (everyday living) Abnormal (tension or accident) Normal (everyday living) Abnormal (tension or accident) Appropriate Appropriate (According to demand) Inappropriate Inappropriate Feels good Feels bad Feels bad Feels worse (out of proportion to demand) It is my experience that many, if not most people who have suffered with chronic back and neck pain never reach the end of the road and will never be balanced and strong. Somewhere along the line, for some reason, they get bogged down. They may be fine
2 for a while, but they remain at risk. Eventually, almost inevitably, they fall again. The intention of this article is to begin an examination of the process so that, if pain is bogging a person down, they may know where to look to help get them going again; to help bring it to its potential conclusion. Before discussing something as complex and controversial as why some patients heal while others never will, it is necessary to define healing. Healing is a process by which damage is repaired so that a (person) structure may respond appropriately to both normal and abnormal demands. To heal something is to reconstruct it; to put it back together. It is the opposite of wounding and degeneration. How does one respond appropriately? In the first few days after the accident, Rosalie stayed in bed and was in considerable pain. She was put on Percocet and Motrin. Within a week, she had progressed to the point where she hurt constantly, but was at least able to move around. Her doctor prescribed physical therapy, kept her on muscle relaxants, anti-inflammatories, and when needed, pain relievers. Today, the pain is much less, but she remains unable to reach her upper kitchen cabinets and it still hurts to wave goodbye. Rosalie s response to normal demands is inappropriate. Chart II (Healing Versus Wounding) Condition Damaged Completely Dysfunctional (Can t be used) Hurts All the Time Hurts most of the time Questionable (Hurts irregularly) Feels O.K. (Doesn t hurt but doesn t feel normal; still vulnerable.) Condition Healing Resolution (Doesn t hurt but doesn t move) Feels not bad (Not strong but not vulnerable) Feels good (Don t need to think about it.) Feels Great (Balanced and strong) Example Rosalie s L back at time of accident Rosalie s R back after painting Rosalie s L back two months after accident Rosalie s L back now Example Rosalie s R back usually Rosalie s R back occasionally Rosalie s right side has never been injured; it is, she reports, just fine. When she overuses it, it does hurt, but never out of proportion to what she s done. Last month, for instance, she painted part of her living room ceiling and her right upper back and neck were sore. Within a couple of days, the area felt fine again. Rosalie is a high-powered executive secretary and I once asked her how her back responds to the pressure. The shoulders get really tight, she said. But if the right side hurts, the left side kills. The same degree of emotional stress affects one side much more than the other. If Rosalie were involved in another accident, what might happen? In an accident her right shoulder she would hurt of course, but only to the degree that it was injured. Her
3 left upper back had already been injured and its response to the accident might be very different. An abnormal demand such as another accident may cause a reaction totally out of proportion to the actual event. Already weakened, another stress might compound the injury and make her left upper back and neck completely unusable. Rosalie s right upper back has no problems; it is healthy. Under normal demands (everyday living) it feels fine. When she exercises regularly and takes care of herself, it feels even better; it feels good. Under abnormal conditions (painting ceilings or an accident) it responds as it should: it hurts. A little stress hurts a little; a big stress hurts a lot. Rosalie s left side is damaged; although not as bad as it was two years ago, it s still not healed. It s been healing, but remains on the damaged end of the ledger. Abnormal demands can set off a seriously inappropriate response. When Rosalie was referred to me by her orthopedist, we did an initial interview. I asked her about her life, her pain, her medical history, her expectations about our work together. In discussing her experience with physical therapy, her reactions were generally negative. I asked her why she didn t get anything from therapy and she said that she had gone twice weekly for about two months but not much had happened. Further discussion, however, revealed a different story. What had happened was that she had improved about 25 percent, it turned out but when she left she was still hurting. On the chart she had moved three spaces: from can t be used, when she began therapy, to somewhere between hurts most of the time and hurts irregularly. This reaction to therapy is commonplace. Rosalie, like most of us, saw pain as an all or nothing condition. If it still hurts, even at a reduced level, our tendency is to discredit the therapy. She didn t view healing as the charts show it: a continuum. The progression from wounded to healed is just that a progression. Healing is a process, by definition it involves time. Healed is the positive end result of that process. Almost always the success we achieve today is built upon the work we did yesterday. A back is not healed if the injury continues to significantly detract from the sufferer s physical emotional or spiritual well-being. The important word here is significantly. Healing is not always synonymous with good as new. It is a relative term it may not be perfect. It is a subjective term, what feels good to one person may be only okay to another. But if the result of the injury is that there is a significant, limiting physical, emotional or spiritual adaptation, the condition has not been healed. A fully healed back is pain free positive, even quite supportive and strong: it is not just not bad, it is good. Do healed backs ever hurt? Of course they do. Healed or not, structures subjected to abnormal demands will complain. The point is that a totally healed structure will not complain disproportionately to the demand. All things being equal, it is not a weakened
4 link that will break under normal stress or will break inappropriately under abnormal stress. In a recent Physical Therapy Forum, Patricia Lyall, RPT and Arun Hejmadi, Ph.D., wrote a provocative article entitles A new Paradigm for Working with Chronic Myofascial Pain. As I understand their model, our brain has developed into a tri-level structure and that treatment which bridges the gap between subcortical needs and cortical expectations will be most effective with chronic pain patients. This conception, if it holds up, will help explain why techniques like P.N.F., Feldenkrais, Rolfing, Alexander Work, unwinding, relaxation techniques, even psychotherapy, are something very helpful. All of these methods, to a greater or lesser degree, reach a sub-cortical level. And yet, after ten years as a Rolfer, with close to ten thousand client hours of soft tissue and joint mobilization; with experience in movement work, meridian (acupuncture) energy, psychotherapy, trigger point compression, unwinding, cranio-sacral techniques, guided visualization and other subcortical methods; I know that while many chronic pain patients get better, there are still some who don t. Those who reach all the way to being fully healed are, sad to say, a relatively small minority. A realistic prognosis for a chronic back condition is that often the discomfort which accompanies a specific episode can be temporarily relieved; that over the years the condition will be slowly and painfully adapted to and, through a process of compensatory rigidification, more or less resolved; that only rarely will a back be healed to the point where it is no longer a significant issue in the sufferer s life. All back pain in its original cause, its location, duration, intensity, quality, and reasons for recurrence is not the same. The taxi driver whose low back begins to ache after twenty minutes in his cab may or may not have the same problem as the surgeon whose right leg throbs after an hour in the operating room. The school teacher who experiences excruciating stiffness every morning cannot be treated the same as the physical therapist whose pain occurs at one end of the day. The damage done and the repair needed to take Rosalie to the place that she no longer needs to think about it is, and must be, different from anyone else. There are no simple remedies for complex problems, no exercises that everyone should do, no root cause that explains all discomfort, no one method or cure that fixers everything. The specific rehabilitative process a suffered undertakes is for him; it must be designed for his life, his pain, his structure. It is not transferable. What is transferable, what is universal, are the fundamentals as opposed to the specifics of healing such conditions. The components involved will differ with the individual. The healing process can be stopped, slowed down, or revered at any one of these steps. If the process is stopping, slowing down or reversing, I suggest these are the areas which should be examined. Something in one of the following six categories has gone astray. Although, I call these categories steps, and I write about them in order, they are not necessarily sequential, linear progressions which we move through one at a time. Often, many of the components must be dealt with simultaneously.
5 The fundamentals involved in healing chronic back and neck pain are: 1) commitment to the process of healing; 2) appropriate evaluation of the issues; 3) correction of the structural problems; 4) lengthening what has shortened and strengthening what has weakened; 5) learning balanced movement; and 6) avoidance of reinjury. Healing is natural; it is at the heart of life. If the tissue is viable and the work is done, healing will take place. Healing is the condition we enter when the initial wounding is over. There are almost always ups and downs, plateaus during which nothings seems to be happening. But as long as the overall movement is toward repair, we are healing. If healing stops or is incomplete, we may revert to any combination of stalemate, more wounding, degeneration or dysfunctional compensation. A healed back moves freely; it is not painful. It is something we don t need to think about. Unafraid, we can take it anywhere. In future issues of PT Forum, I hope to discuss what Rosalie has and has not been doing; to look at the nature of the process that begins with wounding and can end as healed. It is my intention to contribute articles discussing each of these categories. Chart III THE COMPONENTS INVOLVED IN HEALING CHRONIC BECK AND BACK PAIN Commitment to the process of healing Appropriate evaluation of the issues Correction of the structural problems Lengthening what has shortened, strengthening was has weakened Learning of balanced movement Avoidance of re-injury ****************** January, 2009 In fact, what happened was that I spent the next number of years writing what I hoped would be an eight part television documentary and an accompanying book about the healing process. After a great deal of effort, I realized that what interested me was not the repair of back pain, but what happened to a person s body, mind and soul as they got better. The result was a proposal for a motion picture about what grace looks like. If you are interested, you will find the proposal on this website.
6
Self-directed support
Self-directed support Mental health and self-directed support Self- directed support is for everyone who is eligible for social care funding. This answers some of the most commonly heard questions about
More informationThe Invisible Driver of Chronic Pain
1 The Invisible Driver of Chronic Pain This guide is for people who ve tried many different treatments for chronic pain - and are still in pain. www.lifeafterpain.com 2 How would you like to get to the
More informationMyofascial Pain Syndrome Case Study by Meg Syfan
Myofascial Pain Syndrome Case Study by Meg Syfan The following case study is with my client who has been diagnosed with Myofascial Pain Syndrome. My hope is that this information will give insight and
More informationAn Interview with a Chiropractor
An Interview with a Chiropractor Doctor Scott Warner took the time out of his busy schedule to talk to us about chiropractic medicine what it is, what it isn t, and why he chose it as a profession. What
More informationThe Invisible Cause of Chronic Pain
1 The Invisible Cause of Chronic Pain This guide is for people who ve tried many different treatments for chronic pain - and are still in pain. www.lifeafterpain.com 2 How would you like to get to the
More informationControlling Worries and Habits
THINK GOOD FEEL GOOD Controlling Worries and Habits We often have obsessional thoughts that go round and round in our heads. Sometimes these thoughts keep happening and are about worrying things like germs,
More informationLetter to the teachers
Letter to the teachers Hello my name is Sasha Jacombs I m 12 years old and I have had Type 1 Diabetes since I was four years old. Some of the people reading this may not know what that is, so I had better
More informationDealing with Depression Feature Article July 2008
Dealing with Depression Feature Article July 2008 Marjorie and Ann were housemates for about three years. Everyone thought that they did not like each other very much. Direct support staff said that they
More informationMaking Your Treatment Work Long-Term
Making Your Treatment Work Long-Term How to keep your treatment working... and why you don t want it to fail Regardless of the particular drugs you re taking, your drugs will only work when you take them.
More informationSome Important Concepts in EFT
Measuring Intensity Some Important Concepts in EFT Measuring intensity is extremely important because it gives a benchmark of the progress made. It also indicates when the problem has gone, and it is important
More informationWhy Is Mommy Like She Is?
Why Is Mommy Like She Is? A Book For Kids About PTSD Deployment Edition Patience H. C. Mason Patience Press High Springs, Florida PP Patience Press 2010 by Patience Mason All rights reserved. No part of
More informationOnes Way of Thinking. Every day, people make decisions that determine where the next step we take in life will
Guerrero 1 Ypani Guerrero Prof Serpas Exp 389 11/28/12 Ones Way of Thinking Every day, people make decisions that determine where the next step we take in life will be. We often don t know whether those
More informationLower Back Pain and Irritable Bowel Syndrome
Lower Back Pain and Irritable Bowel Syndrome Written by Scott Best Is there a correlation between lower back pain and Irritable Bowel Syndrome? Researchers have long argued that IBS may be caused by abnormal
More informationPsychological Factors and Issues in Return to Play After ACL Reconstruction JAKI HITZELBERGER, LMHC, MGCP
Psychological Factors and Issues in Return to Play After ACL Reconstruction JAKI HITZELBERGER, LMHC, MGCP Athlete s Perception ACL INJURY continuum This is the worst thing that could ever happen to me
More informationNews English.com Ready-to-use ESL / EFL Lessons
www.breaking News English.com Ready-to-use ESL / EFL Lessons The Breaking News English.com Resource Book 1,000 Ideas & Activities For Language Teachers http://www.breakingnewsenglish.com/book.html Yoga
More informationHelping Your Asperger s Adult-Child to Eliminate Thinking Errors
Helping Your Asperger s Adult-Child to Eliminate Thinking Errors Many people with Asperger s (AS) and High-Functioning Autism (HFA) experience thinking errors, largely due to a phenomenon called mind-blindness.
More informationOPIOIDS. Questions about opioids, and the Answers that may SURPRISE YOU. A booklet for people who may benefit from reducing or stopping their opioid
OPIOIDS Questions about opioids, and the Answers that may SURPRISE YOU A booklet for people who may benefit from reducing or stopping their opioid Generic Name morphine hydromorphone oxycodone tramadol
More informationOPIOIDS. Questions about opioids, and the Answers that may SURPRISE YOU. A booklet for people who may benefit from reducing or stopping their opioid
OPIOIDS Questions about opioids, and the Answers that may SURPRISE YOU A booklet for people who may benefit from reducing or stopping their opioid Generic Name morphine hydromorphone oxycodone tramadol
More informationEFT: What is it? EFT is like acupuncture without the needles.
Tapping to Health What is EFT? It is a very simple procedure that anyone can learn and use to alleviate stress or anxiety, and all the ways those emotions manifest themselves in our lives. Often you ll
More informationPaul Figueroa. Washington Municipal Clerks Association ANNUAL CONFERENCE. Workplace Bullying: Solutions and Prevention. for
Workplace Bullying: Solutions and Prevention for Washington Municipal Clerks Association ANNUAL CONFERENCE Paul@PeaceEnforcement.com 206-650-5364 Peace Enforcement LLC Bullying described: Why people do
More information2 INSTRUCTOR GUIDELINES
STAGE: Not Ready to Quit (Ready to cut back) You have been approached by Mr. Faulk, a healthy young male, aged 28, who has applied to become a fireman and has a good chance of being offered the job. His
More informationChoosing Life: empowerment, Action, Results! CLEAR Menu Sessions. Adherence 1: Understanding My Medications and Adherence
Choosing Life: empowerment, Action, Results! CLEAR Menu Sessions Adherence 1: Understanding My Medications and Adherence This page intentionally left blank. Understanding My Medications and Adherence Session
More informationLiving My Best Life. Today, after more than 30 years of struggling just to survive, Lynn is in a very different space.
Living My Best Life Lynn Allen-Johnson s world turned upside down when she was 16. That s when her father and best friend died of Hodgkin s disease leaving behind her mom and six kids. Lynn s family was
More informationTreating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009
Treating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009 GRACE, the Global Resource for Advancing Cancer Education, is pleased to provide the following
More informationDepression: what you should know
Depression: what you should know If you think you, or someone you know, might be suffering from depression, read on. What is depression? Depression is an illness characterized by persistent sadness and
More informationWhat is the Difference Between Myotherapy and Remedial Massage?
What is the Difference Between Myotherapy and Remedial Massage? We can only imagine how difficult life must have been for the sick a hundred or more years ago. When they were sick they had very limited
More informationWelcome to NHS Highland Pain Management Service
Welcome to NHS Highland Pain Management Service Information from this questionnaire helps us to understand your pain problem better. It is important that you read each question carefully and answer as
More informationLet s talk about what goes wrong with the shoulder. The first problem is things that occur underneath the acromion.
Shoulder Impingement Part 2 Let s talk about what goes wrong with the shoulder. The first problem is things that occur underneath the acromion. This is the subacromial space, which is one of those apparent
More informationDepression. Northumberland, Tyne and Wear NHS Trust (Revised Jan 2002) An Information Leaflet
Depression Northumberland, Tyne and Wear NHS Trust (Revised Jan 2002) An Information Leaflet practical ldren 1 7XR isle, d n. ocial These are the thoughts of two people who are depressed: I feel so alone,
More informationAdult Asthma My Days of Living in Tension with Asthma are Over!
Published on: 9 Jul 2014 Adult Asthma My Days of Living in Tension with Asthma are Over! Introduction This is a recent picture, taken when we went on a family picnic. We climbed up this big hill and I
More informationNautilus & Athletic Journal Articles
Nautilus & Athletic Journal Articles ArthurJonesExercise.com Featuring the Lower Back Machine While the title of this article may lend itself to argument, it is certainly true that the lower back is, at
More informationExcerpted From "Staying Sober" By: Terence T. Gorski
Excerpted From "Staying Sober" By: Terence T. Gorski With additions by: Lee Jamison When most people think about alcoholism or drug addiction they think only of the alcohol/drug-based symptoms and forget
More informationCARPAL TUNNEL SYNDROME
A Patient s Guide to CARPAL TUNNEL SYNDROME Improved Treatment with Active Release Treatment Dr Jason Gray BHK DC MSc Dr Stephanie Gray BSc DC GRAYCHIROPRACTIC Improved Treatment For Carpal Tunnel Syndrome
More informationDepression Major Depressive Disorder Defined. by Yvonne Sinclair M.A.
Depression Major Depressive Disorder Defined. by Yvonne Sinclair M.A. Have you been feeling sad a lot lately, can t seem to shake the blues. Do you know someone who has changed, no energy, lack of concentration,
More informationTHE IMPACT OF OUR PRESS, MEDIA AND INFORMATION AND ADVICE
1 THE IMPACT OF OUR PRESS, MEDIA AND INFORMATION AND ADVICE 2 CONTENTS Stand Alone s website Information and Advice Focus on Christmas - December 2015 Other press work in 2015 The overall impact of our
More informationTip sheet. A quick guide to the dos and don ts of mental health care and inclusion. 1. Ask questions. Practical tips
A quick guide to the dos and don ts of mental health care and inclusion Much of the rejection felt by those in church with mental health problems comes from accidental actions and words, delivered with
More informationGENERAL BEHAVIOR INVENTORY Self-Report Version Never or Sometimes Often Very Often
GENERAL BEHAVIOR INVENTORY Self-Report Version Here are some questions about behaviors that occur in the general population. Think about how often they occur for you. Using the scale below, select the
More informationStress levels in people today are higher than ever. Our world is much faster paced than
Jolie Frye Intrapersonal Communication Meditation and Self Talk: Dealing with Stress Stress levels in people today are higher than ever. Our world is much faster paced than ever before. People pile on
More informationADHD clinic for adults Feedback on services for attention deficit hyperactivity disorder
ADHD clinic for adults Feedback on services for attention deficit hyperactivity disorder Healthwatch Islington Healthwatch Islington is an independent organisation led by volunteers from the local community.
More informationIncreasing plasma donation frequency: Insights from current donors
Increasing plasma donation frequency: Insights from current donors Dr Rachel Thorpe Research and Development, Australian Red Cross Blood Service Background Retained plasmapheresis donors are critical to
More informationUnderstanding Pain. Teaching Plan: Guidelines for Teaching this Lesson
Understanding Pain Teaching Plan: Guidelines for Teaching this Lesson Lesson Overview This one-hour lesson plan is about pain and how your workers should respond to and care for residents with pain. You
More informationMultitasking: Why Your Brain Can t Do It and What You Should Do About It.
Multitasking: Why Your Brain Can t Do It and What You Should Do About It. Earl K. Miller The Picower Institute for Learning and Memory and Department of Brain and Cognitive Sciences, Massachusetts Institute
More informationThe Phoenix/New Freedom Mental Health Programming
The Phoenix/New Freedom Mental Health Programming Phoenix/New Freedom Mental Health Programming Orientation/Introduction to Programming The following model represents a program designed for 14 mental health
More informationH e a l th Whole Health and Exercise o n
Page 1 Whole Health and Exercise Youth will be able to identify specific exercises they can perform to enhance their health through physical activity. Youth will also be able to identify the components
More information5 Keys to a Pain Free Life Alex Wiant DC
5 Keys to a Pain Free Life Alex Wiant DC If you are living with pain, this booklet could be the most important thing you read this year. The causes of pain are not a mystery. Before I get in to how to
More informationA Patient s Guide to Chronic Pain Management
A Patient s Guide to Chronic Pain Management 264 Pleasant Street Concord, NH 03301 Phone: 6032243368 Fax: 6032287268 marketing.copa@concordortho.com DISCLAIMER: The information in this booklet is compiled
More informationLee's Martial Arts. The Five Principles. Principle #1: Preventive Defense. Principle #2: Awareness
The Five Principles Principle #1: Preventive Defense Preventive Defense is to always respect. Do not offend anyone verbally or physically to cause a confrontation. Respect Rule 1: Watch what you think,
More informationMALE LIBIDO- EBOOKLET
MALE LIBIDO- EBOOKLET Hi there, Thank you for ordering this Native Remedies ebooklet! ebooklets are modified from consultations with real people and cover some of the most frequently dealt with problems
More informationINTRODUCTION. Okay, let's get started.
INTRODUCTION This guide will help you determine if you have the hidden triggers to CHRONIC headaches. Find out if you have an underlying condition often overlooked when trying to eliminate headaches. Physicians
More informationCBT+ Measures Cheat Sheet
CBT+ Measures Cheat Sheet Child and Adolescent Trauma Screen (CATS). The CATS has 2 sections: (1) Trauma Screen and (2) DSM5 sx. There are also impairment items. There is a self-report version for ages
More informationSUFFERING WITH ACHES & PAINS?
Health & Fitness The Newsletter About Your Health And Caring For Your Body SUFFERING WITH ACHES & PAINS? What different types of pain can tell you When you have an ache or pain it can leave you scratching
More informationTable of Contents FOREWORD THE TOP 7 CAUSES OF RUNNING INJURIES 1) GET IN SHAPE TO RUN... DON T RUN TO GET IN SHAPE.
Table of Contents FOREWORD THE TOP 7 CAUSES OF RUNNING INJURIES 1) GET IN SHAPE TO RUN... DON T RUN TO GET IN SHAPE. 2) A PROPER WARMUP IS WORTH YOUR TIME. NO RUN IS WORTH AN INJURY. ) THE ARCH WAS NOT
More informationHeadache & Migraine Survival Guide 4 Steps To Manage Your Pain
Headache & Migraine Survival Guide 4 s To Manage Your Pain Why this Guide? According to the National Institute of Neurological Disorders and Stroke (NINDS) and the American Council for Headache Education
More informationUncovering Significant Emotional Events (S.E.E.'s):
Uncovering Significant Emotional Events (S.E.E.'s): In this article I am going to explain to you what S.E.E. s are and why uncovering them is so important to achieve social confidence. You will read almost
More informationHeather Feather s 3 Keys To Find Relief From Plantar Fasciitis Blueprint. By Heather Feather The Pain Free Feet Guide
Heather Feather s 3 Keys To Find Relief From Plantar Fasciitis Blueprint By Heather Feather The Pain Free Feet Guide Heather Feather s 3 Keys To Kick Plantar Fasciitis To The Curb Blueprint To get the
More informationPsychodynamic Therapy 101 An interview with Dr. Jonathan Shedler Post published by Jonathan Shedler PhD on Nov 22, 2013 i
Psychodynamic Therapy 101 An interview with Dr. Jonathan Shedler Post published by Jonathan Shedler PhD on Nov 22, 2013 i In this interview with Dr. Daniel Carlat (DC) for The Carlat Psychiatry Report
More informationWhy choose Ottauquechee PT
Why does your back hurt? Low back pain is one of the most common patient complaints affecting 80% of adults at some point in their lives. Generally the source of pain is in the spine and/or its supporting
More informationTOGETHER. Vision. Determined. Grateful. Inspired. We invite you to be a part of VCB and join us on this journey. TWO ONE THREE
Vision TOGETHER VCB Helping Those with Vision Loss 2018 ONE Grateful TWO Inspired THREE Determined Every year, Valley Center for the Blind helps hundreds of people who are experiencing vision loss live
More information19 INSTRUCTOR GUIDELINES
STAGE: Recent Quitter You are a pharmacist in a smoking cessation clinic and you receive a phone call from one of your patients, Ms. Onitay. She is moderately panicked and tells you that she has a swollen
More informationAn INSIDE OUT Family Discussion Guide. Introduction.
An INSIDE OUT Family Discussion Guide Introduction A Biblically- based tool to help your kids talk about their feelings using the popular Pixar movie. God made every person with the unique ability to feel
More informationHow to Work with the Patterns That Sustain Depression
How to Work with the Patterns That Sustain Depression Module 5.2 - Transcript - pg. 1 How to Work with the Patterns That Sustain Depression How the Grieving Mind Fights Depression with Marsha Linehan,
More informationFrom broken down to breaking through.
22 From broken down to breaking through. Stephen Travers Stephen Travers is a hypnotherapist and NLP practitioner based in Dublin, Ireland. H: Stephen, how did you first discover Havening? S: I was reading
More informationProblem Situation Form for Parents
Problem Situation Form for Parents Please complete a form for each situation you notice causes your child social anxiety. 1. WHAT WAS THE SITUATION? Please describe what happened. Provide enough information
More informationMotivational Strategies for Challenging Situations
Motivational Strategies for Challenging Situations Mandy Fauble, PhD, LCSW Executive Director, Safe Harbor Behavioral Health of UPMC Hamot James, Wyler, MA, CPRP Scenario When I talked to her about my
More informationFears. Thanissaro Bhikkhu April, 2003
Fears Thanissaro Bhikkhu April, 2003 We re afraid of so many things. There s so much fear in our lives. And yet the texts don t treat fear all that much, largely because there are many different kinds
More informationGABRIEL METHOD FAT TRIGGER REPORT
GABRIEL METHOD FAT TRIGGER REPORT Lifestyle Stress How Lifestyle Stress is Affecting Your Weight and whether your stress is emotional, physical, or buried in your unconscious mind...... your body reacts
More informationThe 5 Things You Can Do Right Now to Get Ready to Quit Smoking
The 5 Things You Can Do Right Now to Get Ready to Quit Smoking By Charles Westover Founder of Advanced Laser Solutions Copyright 2012 What you do before you quit smoking is equally as important as what
More informationChapter 3 Numbers Count
Chapter 3 Numbers Count IN THE LAST CHAPTER, WE wrote that you must identify the symptoms you want to free yourself from the symptoms you suspect your slow metabolism is causing. After identifying them,
More informationQUESTIONS ANSWERED BY
Module 16 QUESTIONS ANSWERED BY BERNIE SIEGEL, MD 2 Q How do our thoughts and beliefs affect the health of our bodies? A You can t separate thoughts and beliefs from your body. What you think and what
More informationStep One. We admitted we were powerless over our addictions and compulsions --that our lives had become unmanageable.
Step One We admitted we were powerless over our addictions and compulsions --that our lives had become unmanageable. I know that nothing good lives in me, that is, in my sinful nature. For I have the desire
More informationTime for Change. The Challenge Ahead
Time for Change The Challenge Ahead Who I am My name is Sir Stephen Bubb. I am the big boss of ACEVO. ACEVO supports the big bosses of charities and other groups. What this report is about This report
More informationPractical Skills for Working with Clients Who Are Angry
Practical Skills for Working with Clients Who Are Angry - Video 9 Hanson, PhD and Z. Segal, PhD - Transcript - pg. 1 Practical Skills for Working with Clients Who Are Angry Two Ways to Work with a Passive-Aggressive
More informationIt s About You Too! A guide for children who have a parent with a mental illness
It s About You Too! A guide for children who have a parent with a mental illness You ve been given this book because your Mum or Dad has a mental illness. This book tells you about mental illness. It also
More informationHi, this is Dr. Osborne and today I have a very special guest for you.
Gluten Free Exercise Series - Pilates Hi, this is Dr. Osborne and today I have a very special guest for you. Sylvia Favela is an expert in Pilates and an expert in home-based Pilates programs for people
More informationPROFESSIONAL BACKGROUND: I am a psychiatrist in private practice in. Watertown, Massachusetts (see attached resume). I have a longstanding
TESTIMONY FOR MDMA HEARING... Submitted by: Richard Ingrasci, M.D., M.P.H. 173 Mr. Auburn St., Watertown, MA 02172 (617) 923-4601 PROFESSIONAL BACKGROUND: I am a psychiatrist in private practice in Watertown,
More informationSelf-Injury. What is it? How do I get help? Adapted from Signs of Self-Injury Program
Self-Injury What is it? How do I get help? Adapted from Signs of Self-Injury Program Why are we doing this? *Prevention of self-injury-it s happening so why ignore it? *Statistics show high prevalence
More informationConcussion or Mild Traumatic Brain Injury
Concussion or Mild Traumatic Brain Injury Concussion or Mild Traumatic Brain Injury Table of Contents What is concussion... 2 Causes... 3 Symptoms..3-4 When to get treatment...4-5 Daily activities. 5 Return
More informationTelling Our Stories, Healing Our Hearts. BIAMA Keynote Address. March 26, I recently read Viktor Frankl s book Man s Search for
Telling Our Stories, Healing Our Hearts BIAMA Keynote Address March 26, 2015 I recently read Viktor Frankl s book Man s Search for Meaning. For those of you who don t know Viktor Frankl was a neurologist
More informationShoulder Resurfacing & Joint Preservation
Shoulder Resurfacing & Joint Preservation Do you have pain in your shoulder that prevents you from doing the activities of daily life? Has your doctor told you that you might need a joint replacement?
More information100 TOEIC GRAMMAR QUESTIONS. by Jeffrey Hill
100 TOEIC GRAMMAR QUESTIONS by Jeffrey Hill 1 Look, it..! a) s raining b) rains c) has rain d) rain 1 Look, it..! a) s raining b) rains c) has rain d) rain 2 She..me last week. a) phones b) has phoned
More informationWeek 3: Exploring Reactivity
Pu ng Mindfulness to Work Each of the mindfulness techniques you are prac cing provides you with a different way to bring mindfulness to life. The first prac ce, the 20 Breaths exercise, allows you to
More informationIntimacy Anorexia: The Book. By Douglas Weiss, Ph.D.
Intimacy Anorexia: The Book By Douglas Weiss, Ph.D. Chapters Contents 1 What is it? 11 2 Characteristics 31 3 Causes 57 4 Initiating Anorexic Patterns 71 5 Is it an Addiction? 77 6 Addiction Continuum
More informationCOUNSELING INTERVIEW GUIDELINES
Dr. Moshe ben Asher SOC 356, Introduction to Social Welfare CSUN, Sociology Department COUNSELING INTERVIEW GUIDELINES WHAT DISTINGUISHES A PROFESSIONAL FROM OTHER KINDS OF WORKERS? Education and training
More informationPost-Operative Laparoscopic Appendectomy Guide. Dr. Buck Parker, MD FACS Board Certified Surgeon
Post-Operative Laparoscopic Appendectomy Guide Dr. Buck Parker, MD FACS Board Certified Surgeon www.drbuckparker.com Thanks! Thanks so much for downloading my laparoscopic appendectomy guide! This guide
More informationESL Health Unit Unit Four Healthy Aging Lesson Two Exercise
ESL Health Unit Unit Four Healthy Aging Lesson Two Exercise Reading and Writing Practice Advanced Beginning Checklist for Learning: Below are some of the goals of this lesson. Which ones are your goals
More informationBill Wilson & The 12 Steps Steve H. Johnson City, Tennessee
Bill Wilson & The 12 Steps by Steve H. Johnson City, Tennessee Copyright 2010 Steve H. This document may be distributed freely as long as nothing is changed in any way. Introduction I suppose anyone who
More information"PCOS Weight Loss and Exercise...
"PCOS Weight Loss and Exercise... By Dr. Beverly Yates Dr. of Naturopathic Medicine, PCOS Weight Loss Expert & Best Selling Author Table of Contents Introduction... 2 If You Are Dieting Do You Need To
More informationSection 4 - Dealing with Anxious Thinking
Section 4 - Dealing with Anxious Thinking How do we challenge our unhelpful thoughts? Anxiety may decrease if we closely examine how realistic and true our unhelpful/negative thoughts are. We may find
More informationChapter 1. Dysfunctional Behavioral Cycles
Chapter 1. Dysfunctional Behavioral Cycles For most people, the things they do their behavior are predictable. We can pretty much guess what someone is going to do in a similar situation in the future
More informationBy Brianne Masselli and Johanna Bergan Youth M.O.V.E. National. A Guide for Youth. Understanding Trauma
By Brianne Masselli and Johanna Bergan Youth M.O.V.E. National A Guide for Youth Understanding Trauma For National Technical Assistance Center for Children s Mental Health Georgetown University Center
More informationFIGURE 1-The Cognitive Model. Core belief. I m incompetent. Intermediate belief. If I don t understand something perfectly, then I m dumb
FIGURE 1-The Cognitive Model Core belief I m incompetent Intermediate belief If I don t understand something perfectly, then I m dumb Situation Automatic thoughts Reactions Reading this book This is too
More informationThe Importance of Forgiveness. Father, Son, Ourselves.
The Importance of Forgiveness. Father, Son, Ourselves. Forgive for Good: Presentation: Maria Daehler, MD. Author: Fred Luskin, PhD. Slides: Mariadaehler@gmail.com Breath of Thanks - modified Heart FocusB
More informationPain Notebook NAME PHONE. Three Hole Punch Here Three Hole Punch Here. Global Pain Initiative 2018 Ver 1.0
Pain Notebook Three Hole Punch Here Three Hole Punch Here NAME EMAIL PHONE Global Pain Initiative 2018 Ver 1.0 What is pain? Pain is a bad sensation that tells you something is wrong. Pain falls into two
More informationThe Gift of Change. about how sudden money is more about the change and transition than it is about
The Gift of Change One of our mantras at the Sudden Money Institute is: Change is a gift. We talk about how sudden money is more about the change and transition than it is about the money. Everyone focuses
More informationThe Value of Professional Kettlebell Training
The Value of Professional Kettlebell Training A Brief Introduction to the Agatsu Kettlebell Certification By Robert Dobó The Agatsu Kettlebell Certification consists of a three day course, Instructor are
More informationStep 2 Challenging negative thoughts "Weeding"
Managing Automatic Negative Thoughts (ANTs) Step 1 Identifying negative thoughts "ANTs" Step 2 Challenging negative thoughts "Weeding" Step 3 Planting positive thoughts 'Potting" Step1 Identifying Your
More informationDOCTOR: The last time I saw you and your 6-year old son Julio was about 2 months ago?
DOCTOR: The last time I saw you and your 6-year old son Julio was about 2 months ago? MOTHER: Um, ya, I think that was our first time here. DOCTOR: Do you remember if you got an Asthma Action Plan? MOTHER:
More informationHow to Work with the Patterns That Sustain Depression
How to Work with the Patterns That Sustain Depression Module 1.2 - Transcript - pg. 1 How to Work with the Patterns That Sustain Depression How to Transform a Client s Low Motivation Into an Ally Against
More informationTHE EATING GUIDELINES
THE EATING GUIDELINES The Eating Guidelines are the core of the Breaking Free program. They are as follows: 1. Eat when you are hungry. 2. Eat sitting down in a calm environment. This does not include
More information